Eye Atlas—Severe Non-Proliferative Diabetic Retinopathy
This is the retina of the left eye of a 48-year-old female who has had diabetes type 2 for about 20 years. Despite her use of oral medication and insulin, her blood sugar is unstable.
Diabetes damages the blood vessels, resulting in leaking. The little red spots that dot the retina are tiny hemorrhages from where blood has leaked from these blood vessels. You will also notice a collection of yellowish-white material in the very center. This material is called exudate and is made of proteins that have leaked from the blood vessels.
This patient has fluid that has also leaked centrally. This is difficult to appreciate in a two-dimensional image, but when we view it through our instruments we can see the buildup of fluid. The buildup in fluid has reduced this patient’s visual acuity to 20/100. If the patient did not have this accumulation of fluid, she would see 20/20, despite all the hemorrhages. That is why it is so important for diabetic patients to have their eyes examined; they could have a lot of activity but notice little change to their vision.
Of most concern in this patient are the white fuzzy splotches at the top and bottom of this photo. These fuzzy splotches are called cotton wool spots. Cotton wool spots represent areas where the nerves that make up the retina have infarcted. This is a sign that the eye is not getting enough oxygen. Lack of oxygen stimulates the eye to grow new blood vessels, which are fragile and can cause major leaks and threaten vision. This patient has not started to grow these new blood vessels yet, but could soon. When a patient’s retina begins to grow new blood vessels, we call this proliferative diabetic retinopathy.
Proliferative diabetic retinopathy is serious but can be treated with laser surgery, which will cause the new blood vessels to regress. This patient is not at a stage where laser surgery is beneficial. However, because of how advanced the retinopathy is, we will see this patient frequently to closely monitor her condition.